News

A new white paper from the industry bellwether looks back, forward in framing big picture of coding. Benchmarking, the term that encompasses performance measurement in the healthcare industry, will be key for providers seeking to refine their efforts to master ICD-10 as ICD-11 implementation looms in the distance, according to…
Coders need to know when and how the cardiac arrest occurred. There are approximately 350,000-400,000 cases of cardiac arrest arising outside of the hospital setting per year, and not all of these patients make it to the emergency department. The incidence in any given hospital on any given shift is…
There are ICD-10 codes for cold weather injuries.The weather has been rough for the people living in the Midwest and Northeast. The reported temperatures have been as low as -60 with the wind chill factor applied. Such severity of temperatures does calls to mind some injuries and illnesses such as…
Which definition of the deadly condition will be applied in the Empire State has been a hot topic of late. EDITOR’S NOTE: The following is partial transcript of remarks made by Dennis Jones during a recent RACmonitor-produced Monitor Mondays broadcast. First, let me remind everyone that I am in the…
Jan. 30, 2019 is CTE Awareness Day. It has been four years since we started the Patrick Risha CTE (chronic traumatic encephalopathy) Awareness Foundation at stopcte.org. My son, Patrick Risha, was a great high-school football running back and free safety. He started playing at age 10 and over time broke…
Recommended next steps for physician practices are discussed by the author. As you have probably heard by now, a federal judge in Texas, U.S. District Judge Reed O'Connor, on Friday, Dec. 14, 2018 struck down the Patient Protection and Affordable Care Act (PPACA) as unconstitutional, ruling that the individual mandate…
The accurate diagnosis of sepsis is not for DRG assignment. There has been quite a bit of controversy stirred up by UnitedHealthcare (UHC) and its approach to sepsis, and since I am wrapping up a fascinating targeted sepsis project, I want to share what I have learned with you. I…
Higher overturn rates noted when the appeal is filed outside of the payer’s internal appeal process.  I’d like to share some information gained from appealing over 2,000 clinical validation denials for sepsis in the state of New York since the time of the release of the Sepsis-3 criteria in February…